STORIES
With our mission of promoting the advancement of neurosurgical care of the diseases of the brain and spine in underserved
communities worldwide through service, education and support, our journeys have taken us to places where we have witnessed
some of the most inspiring stories of people and the communities they live in.
"Help is a 20 hour ambulance ride away"
by Dr. Philipp Aldana, NOF Founder, President and Chief Medical Officer
With a land mass of approximately 604,000 sq. miles (1,564,000 km2), Mongolia is one of the largest land-locked countries in the world, second only to Kazakhstan. Compared to US states, it is over twice the size of Texas or slightly larger than Alaska. With a population of approximately 3.5 million, it is the most sparsely populated country in the world.
With the National Center for Maternal and Child Health (NCMCH) being the only quaternary children’s hospital in the country, access to specialty pediatric care is limited significantly by distance, compounded by desolate terrain, harsh weather and limited medical and transport infrastructure. I did not comprehend this fully until last Sunday, when I became aware of a case shared with me by one of the surgeons.
Being one of only 2 surgeons covering pediatric neurosurgical cases, Dr. Chulunkhuu, Chairman of the newly formed Department of Neurosurgery at NCMCH, was having coffee with me during what was supposed to be a day of rest. He received a call about an 11 y.o. boy who presented with seizures and was found to have a brain abscess secondary to severe sinusitis. After reviewing the scans that were texted to his phone, it became apparent that the abscess would need drainage through a craniotomy. In the U.S. this would be considered a neurosurgical emergency requiring surgical evacuation with little delay. Dr. Chulunkhuu was able to help initiate medical care by instructing the physicians onsite to administer antibiotics and antiepileptic medication.
In this case, the problem was that the patient was in Ulaangom, a city 860 miles (or 1374 km) away from Ulaanbaataar, about a 20 hour drive away. The patient would have to be transported over land with a nurse, doctor and 2 drivers taking shifts driving the ambulance continuously. The distance assured that the child’s neurosurgical care would be delayed by at least a day increasing the chances of a poor outcome.
Traveling over large distances to receive care in Mongolia is something that the patients and families accept.
With the National Center for Maternal and Child Health (NCMCH) being the only quaternary children’s hospital in the country, access to specialty pediatric care is limited significantly by distance, compounded by desolate terrain, harsh weather and limited medical and transport infrastructure. I did not comprehend this fully until last Sunday, when I became aware of a case shared with me by one of the surgeons.
Being one of only 2 surgeons covering pediatric neurosurgical cases, Dr. Chulunkhuu, Chairman of the newly formed Department of Neurosurgery at NCMCH, was having coffee with me during what was supposed to be a day of rest. He received a call about an 11 y.o. boy who presented with seizures and was found to have a brain abscess secondary to severe sinusitis. After reviewing the scans that were texted to his phone, it became apparent that the abscess would need drainage through a craniotomy. In the U.S. this would be considered a neurosurgical emergency requiring surgical evacuation with little delay. Dr. Chulunkhuu was able to help initiate medical care by instructing the physicians onsite to administer antibiotics and antiepileptic medication.
In this case, the problem was that the patient was in Ulaangom, a city 860 miles (or 1374 km) away from Ulaanbaataar, about a 20 hour drive away. The patient would have to be transported over land with a nurse, doctor and 2 drivers taking shifts driving the ambulance continuously. The distance assured that the child’s neurosurgical care would be delayed by at least a day increasing the chances of a poor outcome.
Traveling over large distances to receive care in Mongolia is something that the patients and families accept.
Distance from Ulaangom to Ulaanbatar, 1374 km. Almost 20 hours of continuous driving to cover that distance. (Google maps)
At the neurosurgery clinic, it was almost routine that we would see patients from locations >1000 km away from the hospital. With more than half the country’s population living in rural locations, this can become a way of life.
Exposure to the conditions of healthcare in Mongolia helps paint a vivid picture of the disparities in health care between our two countries as well as between the urban and rural communities in Mongolia. In the development of pediatric neurosurgery in Mongolia, one of the plans that we are working with NCMCH is the development of centers in the countryside cities that are able to diagnose neurosurgical problems early as well as initiate care. This will take some time to institute. Thanks to programs such as Mongolia Bound, and institutions such as Wolfson Children’s Hospital, Nemours Children’s Health and foundations like the Neurosurgery Outreach Foundation, we are able help the neurosurgeons at NCMCH as they provide care to Mongolia’s children.